Provider Demographics
NPI:1871559427
Name:ELLIOTT, JEANETTE M (CRNP)
Entity type:Individual
Prefix:
First Name:JEANETTE
Middle Name:M
Last Name:ELLIOTT
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 HOT METAL ST
Mailing Address - Street 2:QUANTUM ONE, N431
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15203-2348
Mailing Address - Country:US
Mailing Address - Phone:412-432-5806
Mailing Address - Fax:412-432-7691
Practice Address - Street 1:850 HOSPITAL RD
Practice Address - Street 2:SUITE 1300
Practice Address - City:INDIANA
Practice Address - State:PA
Practice Address - Zip Code:15701-3662
Practice Address - Country:US
Practice Address - Phone:724-349-9444
Practice Address - Fax:724-465-4072
Is Sole Proprietor?:No
Enumeration Date:2006-04-24
Last Update Date:2009-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP004999W363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA11647020OtherCAQH
PA166646OtherSECURITY BLUE
PAS98551Medicare UPIN
PA035158F6VMedicare PIN
PA11647020OtherCAQH